Research Proposal: Literature Concerning ADHD and Substance Abuse Treatment Methods and Outcomes

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ADHD and Substance Abuse

The noticeable high incidence of attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) is a relatively new phenomenon and, as a result, there needs to be considerably more empirical research conducted to know more about this condition. In fact, the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association for mental illness is in the process of being updated and will include more information regarding this illness in adult years. The relationship between ADD/ADHD and substance abuse, for example, is one area that has been studied to some extent but still requires a great deal more research. The for example, does ADHD in childhood increase the risk of developing substance abuse disorders (SUD)? Is the risk of SUD increased or decreased when treating adolescents? Do ADHD teens self-medicate with substances of abuse? The five articles discussed in this literature review shed some light on these questions. However, as noted, all of these studies point to the need for additional research on the connection between ADHD and substance abuse.

Treatment for individuals with both ADHD and substance abuse is one of the areas of main concern, especially since, as is known now, ADHD continues into adolescence, young adulthood and adulthood, when substance abuse has the greatest impact. According to Kolpe and Carlson (2007) from the Departments of Psychiatry and Addiction Medicine, Hennepin County Medical Center in Minneapolis, although there are no epidemiologic studies on ADHD in adults, using studies from childhood and adolescent ADHD, it is estimated that somewhere between.3percent and 2% of adults as a whole may possibly have ADHD. These figures are very different when looking at the co-morbidity of substance abuse and ADHD. Studies report that 30% adult outpatients with ADHD have a substance abuse disorder, 34% have alcoholism, 15 to 35% in cocaine abusers and 24% in mixed use substance abuse users. However, say these authors (Kolpe & Carlson, 2007), the amount of studies on individuals with ADHD and substance abuse and treatment (e.g. methadone) are few. Due to this scarcity of studies, a review of methadone treatment records was conducted to determine the rate of current ADHD symptoms and its influence on treatment outcome.

The authors Kolpe and Carlson (2007) analyzed 687 consecutive admissions to a methadone maintenance program to determine the degree of ADHD symptoms and their relationship with treatment outcome. Of these near 700 admissions, 396 or 58% of the patients self-reported experiencing at least one or ADHD symptom within the two-week before admission, and 131 or 19% of the patients said they had ADHD symptoms that were so severe that they made it very difficult to function in day-to-day activities.

Nine months after these 687 individuals were treated, those who had significant symptoms of ADHD were able to decrease their drug use but were not as able as the control group without ADHD to attain abstinence. The authors discuss the importance of screening for ADHD symptoms in methadone treatment programs and propose interventions believed helpful in improving management of ADHD symptoms and improving outcome. The results of this study are important for a couple of reasons: First, it shows the importance of determining whether or not any methadone treatment candidates have ADHD. It would make many people's treatment outcomes better. It would also be helpful to work with those with ADHH while they were getting treatment to help them better care for their symptoms. The authors (Kolpe & Carlson, 2007) thus recommend that all those getting treatment be screened for ADHD.

Wilson (2007) from the New York State Psychiatric Institute emphasizes that adolescents and adults with substance abuse often have the same symptoms as those with ADHD, such as inattention and impulsivity. In fact these same symptoms of ADHD may contribute to the development of substance abuse by encouraging antisocial behavior. Similar self-regulatory processes could lie under both of these disorders. Some researchers question if stimulant treatment by itself could actually increase substance abuse. Others argue that this stimulant treatment reduces substance abuse. There are even those who say that people with AHDA can become addicted to the stimulants. It encourages positive connections with drugs and teaches youth to use drugs to solve their problems, or, according to others, may even have the youths more sensitive to cocaine. One of the most recent studies in California, for example, of 282 ADHD boys and girls who were followed into adulthood did not find this relationship.

On the other hand, explains Wilson (2007), there are those who say the complete opposite: childhood stimulant treatment may decrease the risk for substance abuse. It is possible, for example, that bad experiences with stimulant treatment, including unpleasant side effects, may keep patients from wanting to do later drug use. One study with 219 boys who were treated with methylphenidate as children, notes Wilson, were associated with fewer diagnoses of alcoholism even beyond the medication treatment itself. The "Iowa Study," with 295 boys between 4 and 12 had a similar finding. Similarly reports Wilson (2007), a meta-analysis by Faraone and Wilen of 674 development aspects of substance abuse and ADHD supplement medicated and 360 un-medicated subjects found almost two times less risk for substance abuse in children treated with stimulants than not. As can be seen by these conflicting studies, more research needs to be conducted to determine more reliability. In fact, most of these studies, both pro and con stimulants are limited by several factors, such as a lack of randomization and placebo control, failure to control for ADHD severity and the presence of too many variables. For example, genetic factors, alone, may have such a major impact that these studies are all moot. This does not mean that research in this area should stop. If anything it is more important to better understand the developmental relationship between ADHD, stimulant treatments and substance abuse to enhance treatment of adults with substance abuse and/or ADHD.

Another factor that needs to be considered with ADHD and substance abuse, according to Faraone et. al, (2007) from SUNY Upstate Medical University, Department of Psychiatry at Harvard Medical School and Pediatric Psychopharmacology unit at Massachusetts General Hospital, is when individuals have late onset ADHD and are more likely to use drugs (not alcohol) than the ADHD non-group. They also have more trouble resisting use of drugs or alcohol and are more apt to report getting high as a reason for their use of drugs. This is a reason say these authors (Faraone et.al, 2007) that it is important that the DSM-IV is being reevaluated for age onset. Farone et. al question if the age at onset criterion of ADHD should be modified when making a diagnosis and changes be made to the diagnostic items and symptom count thresholds when diagnosing ADHD in adults? These questions are even more of concern for those who are diagnosing individuals with substance abuse disorder. Once again the question arises whether the late onset of ADHD may reflect the onset of substance abuse disorder rather than the other way around.

Levin and Mariani (200

As a result, Farone et. al (2007) conduct a study to further assess the validity of late onset and subthreshold ADHD through a detailed evaluation of substance abuse and its complications with adults and ADHD. They hypothesize that late onset ADHD would show a pattern of substance abuse disorder that was like that in full ADHD and that subthreshold ADHD would indicate a lower prevalence of substance abuse disorder than that in full ADHD. For their study, they use ADHD participants between 18 and 55 of age. The researchers find that there is a higher prevalence of substance abuse. For those adults who do not meet full DSM-IV symptom criteria or do not have ADHD at all, there is reduced use and associated negative consequence of use.… [END OF PREVIEW]

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